Medical Marvels

Richmond researchers and practitioners work at the cutting edge of technology

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It’s easy to see popular technology embedded in our lives. Smartphones, streaming services, delivery apps and more are all technological advances meant to make our lives easier.  

In the medical world, tech advances that bring convenience and excitement have found a place, too. Every day, medical professionals test new ways to help people with chronic illnesses, injuries and maladies and apply existing technologies to pressing medical needs. Here’s how some physicians and researchers in our region are expanding the limits of treatments and are embracing technology to take better care of us. 

Breaking Barriers

Dr. K. Singh Sahni has been fixing patients’ brains for four decades. In the early days, patients were in the operating room for hours and then had lengthy hospitalizations and stays in rehabilitation facilities. The process is different now.  

“I did the same [brain] procedure 30 years ago, and now that surgery is [done] as outpatient,” the neurosurgeon says.  

Now the neurosurgery department chair and director of the Neuroscience and Gamma Knife Center at HCA Johnston-Willis Hospital, he is running the first national trial to use focused ultrasound, or FUS, on patients with brain lesions or tumors from lung cancer.  

“The technology is advancing in front of our eyes every day,” Sahni says.

Gamma Knife surgery delivers focused gamma radiation to tumors and diseased areas in the brain. Twenty years ago, Sahni pioneered its use in the Richmond region to noninvasively treat tumors and other problems embedded in the brain. FUS does the same but uses ultrasound to target the spot needing treatment. “It’s so precise because of the navigation technology,” Sahni says. “Gamma Knife is less invasive than surgery, but this is less invasive than Gamma Knife.” 

“As people age, more and more patients need neuroscientific intervention,” he adds. “Technology has advanced so much, we can’t continue just cutting and stitching. The time has come where we can approach neurological problems with minimally invasive techniques.” 

FUS also enables brain treatment that was previously impossible, because the problem is in a part of the brain that is out of reach surgically or through medication. Brain metastases are a common result of cancer elsewhere in the body and are particularly hard to treat because of the body’s blood-brain barrier, which is an evolutionary protection that blocks harmful substances from reaching the brain. The challenge, Sahni says, is that it is also a barrier to cancer medicines. 

“Oncologists have become excellent with new drugs, but patients still were dying,” he says. “Now we have the key to open the door. We can use FUS to disrupt that barrier for a short period of time — three to four hours — and push the drug through.” 

Researchers elsewhere are exploring other uses for FUS. One study in Canada is investigating FUS as a treatment for brain metastases related to breast cancer. Researchers at West Virginia University are exploring FUS as a way to treat Alzheimer’s disease.

“Focused ultrasound for the brain is just the key to the door,” Sahni says. “We’ve opened the door. What we can do once we get in the room, only God knows.”

Prevention First

Forensic psychologist Nicholas Thomson, director of research for the Injury & Violence Prevention Program at VCU Health Trauma Center, remembers how a group of 8-year-olds reacted years ago when they were given virtual reality headsets to simulate a roller coaster ride. “They were so excited; it was the talk of the school for a long time,” he says. 

Now, Thomson is relying on the appeal of virtual reality to help people at high risk of gun violence learn ways to avoid further harm. He was recently awarded a nearly $2 million grant from the U.S. Centers for Disease Control and Prevention to develop and evaluate a program that will feature a roughly 25-minute experience with a virtual reality headset that will create realistic situations to allow participants to role-play nonviolent alternatives to gun violence, showing how they could defuse a situation or disengage safely.   

“[The program] brings the individual into the driver’s seat of responsibility,” Thomson says. “We are empowering the individual, so they understand they don’t have to go down this path.” 

When people who have been injured as a result of community violence come to the VCU Medical Center Main Hospital, they are provided with Bridging the Gap, a voluntary, hospital-based intervention program that began as a study in 2003 and includes a case manager. It’s designed to help patients overcome their injuries, set goals for the future, and avoid future injury and violence. Once Thomson’s study launches, adult victims of gun violence will be offered the chance to enroll in addition to Bridging the Gap. “Patients will still receive the gold standard of care that VCU provides,” Thomson says. “Generally speaking, we know people can learn better with engaging ways. We want to capitalize on that enjoyment and the novelty of it.” 

During the study’s development phase, Thomson and other staff have been gathering feedback from an advisory group that includes adults “who have similar lived experiences as violently injured patients,” Thomson says. With community guidance, the research team creates relevant scenarios and an appropriate aesthetic for the virtual reality session. Response has been positive, he says. “There’s tremendous excitement and engagement about it,” he says. “It really does tell that we’re providing a psychological service that’s appealing.” 

Plus, this technology’s popularity makes the study more appealing, Thomson points out. “As soon as you mention VR, you have buy-in for most people,” he says. “But we need to know if it works. People may do an intervention because it feels good, but it wastes money if it doesn’t work. Everything we do is backed with research.” 

If the study has favorable results, the method can be easily shared. “Headsets are relatively low-cost and portable,” Thomson notes. “We hope we’re creating something that can be deployed in schools and clinics, in rural areas.”  

And while technology is a key element to the treatment, it’s not the focus, Thomson says. “Intervention development has to be person-centered, because that’s who it’s for,” he says. “We will always come back to how [technology] is serving the person.”

Manufactured Solutions Made Real

Veterans turn to the Richmond VA Medical Center for a variety of treatments to raise their quality of life. But sometimes, what a veteran really needs is something that doesn’t exist, like a way to hold a pencil or a custom wheelchair brake handle. That’s where the Richmond Office of Advanced Manufacturing and its manufacturing lab come in. 

In 2010, a team of clinicians and engineers at the Richmond VA began using 3D printing in a clinical setting to make items requested by veterans and their health care providers. The office is now one of only six VA medical centers nationwide with design and manufacturing capabilities in-house. 

“It’s about helping veterans with quality-of-life issues,” says Melissa Oliver, ROAM’s director. “A veteran can go to a doctor, ask for a consultation with a medical technology professional, and that will start the design process.” 

ROAM began with two 3D printers in a small space converted from a loading dock. In January, the division moved into its own two-story building on the medical center’s South Side campus, with printers that use a range of materials (everything from plastic to metal) to create surgical implements, prosthetics, tools and other items meant to make everyday life easier for veterans. Other machines involved in manufacturing — like table and bandsaws, and a vibratory polisher that finishes rough edges — are also on-site, so all processes can be handled in-house. 

The office’s team includes engineers, technicians, surgical fellows and a surgeon working collaboratively with other health care providers to respond to veterans’ requests. “We are embedding engineers at the point of care, so there’s a connection between patients and technology,” says Dr. Michael F. Amendola, chief of the vascular surgery division for the Central Virginia VA Health Care System and the 3D Printing Research Residency program director. 

For a veteran who lost an arm and shoulder to cancer, the team created a prosthetic that enables his shirt to hang properly on his body. Another veteran with a hand tremor asked for a cover for his iPad so he could navigate the screen successfully. A veteran who lacks dexterity and grip strength in her hands from a spinal injury asked for a way to hold a makeup brush. Brian Burkhardt, a rehabilitation engineer and ROAM site leader, designed multiple brushes for her, as well as a carousel brush holder that looks like a flower.  

Other inventions, like a sterilization box for cleaning wheelchairs, have broad applications. It was requested by a nurse at the VA hospital in Tuscaloosa, Alabama, made by team members at ROAM and has since been produced for other VA locations. “A lot of what we make is patient-specific, but it might then become useful for others, benefiting a whole patient population,” Oliver notes.  

Best of all, Amendola adds, ROAM’s financial support from the Department of Veterans Affairs frees them to explore the possibilities of these machines and further push the boundaries. “The magic in the jar is that we can apply clinical expertise without worrying about return on investment,” he says. “The use of technology is, in large part, a value-based investment by the VA. It’s a strategic push: What is the technology, and what will it solve for us?”